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Kidney experts say it's time to remove race from medical algorithms. Doing so is complicated

Rae Ellen Bichell and Cara Anthony, Kaiser Health News on

Published in Health & Fitness

Alphonso Harried recently came across a newspaper clipping about his grandfather receiving his 1,000th dialysis treatment. His grandfather later died — at a dialysis center — as did his uncle, both from kidney disease.

“And that comes in my mind, on my weak days: ‘Are you going to pass away just like they did?’” said Harried, 46, who also has the disease.

He doesn’t like to dwell on that. He has gigs to play as a musician, a ministry to run with his wife, and kids to protect as a school security guard.

Yet he must juggle all that around three trips each week to a dialysis center in Alton, Illinois, about 20 miles from his home in St. Louis, to clean his blood of the impurities his kidneys can no longer flush out. He’s waiting for a transplant, just as his uncle did before him.

“It’s just frustrating,” Harried said. “I’m stuck in the same pattern.”

Thousands of other Americans with failing kidneys are also stuck, going to dialysis as they await new kidneys that may never come. That’s especially true of Black patients, like Harried, who are about four times as likely to have kidney failure as white Americans, and who make up more than 35% of people on dialysis but just 13% of the U.S. population. They’re also less likely to get on the waitlist for a kidney transplant, and less likely to receive a transplant once on the list.

 

An algorithm doctors use may help perpetuate such disparities. It uses race as a factor in evaluating all stages of kidney disease care: diagnosis, dialysis and transplantation.

It’s a simple metric that uses a blood test, plus the patient’s age and sex and whether they’re Black. It makes Black patients appear to have healthier kidneys than non-Black patients, even when their blood measurements are identical.

“It is as close to stereotyping a particular group of people as it can be,” said Dr. Rajnish Mehrotra, a nephrologist with the University of Washington School of Medicine.

This race coefficient has recently come under fire for being imprecise, leading to potentially worse outcomes for Black patients and less chance of receiving a new kidney. A national task force of kidney experts and patients is studying how to replace it. Some institutions have already stopped using it.

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